Individual provider Active NPI

Layla Kidane

  • Adult Health Nurse Practitioner
  • Newark, DE
National Provider Identifier
1124462007
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
LP-0010530 Issued in DE
Practice address
4755 Ogletown Stanton Road
Suite 5A43
Newark, DE 19718-2200
Phone
(302) 623-0188
Fax
(302) 733-5640
NPI assigned
Apr 23, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X LP-0010530 DE
Adult Health Nurse Practitioner 363LA2200X RN212851 GA
Gerontology Nurse Practitioner 363LG0600X LP-0010530 DE
Adult Health Nurse Practitioner 363LA2200X LP-0010530 DE Primary
Registered Nurse 163W00000X RN212851 GA

Addresses

Primary practice location

4755 Ogletown Stanton Road
Suite 5A43
Newark, DE 19718-2200

Mailing address

3232 Oak Vista Way
Lawrenceville, GA 30044-6724

Other practice location 1

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241014000690 DE Practitioner - Nurse Practitioner 9133369499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 623-0188

Hospital & facility affiliations

  • Christiana Hospital Hospital, Newark, DE, CCN 080001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN212851GAMDRegistered Nurse
LP-0010530DEMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Sep 30, 2024 Accepting new patients
Christiana Care Health Services Inc CurrentSince Sep 30, 2024 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Ste 5A43
Newark, DE 19718
Phone (302) 623-0188

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1124462007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 OAK VISTA WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300446724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON ROAD",
            "address_2": "SUITE 5A43",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-623-0188",
            "fax_number": "302-733-5640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3950 Austell Rd",
            "address_purpose": "LOCATION",
            "city": "Austell",
            "state": "GA",
            "postal_code": "301061121",
            "country_code": "US",
            "telephone_number": "770-732-4022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDANE",
        "first_name": "LAYLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-23",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LP-0010530",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN212851",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "DE",
            "license": "LP-0010530",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "DE",
            "license": "LP-0010530",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN212851",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.